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Friday, October 16, 2015

There is a quandary that comes up frequently for me as a visiting nurse. It occurs when a patient has been hospitalized for a life threatening illness, recovers and is sent to a rehab/skilled nursing facility to convalesce. When discharged home the patient is given the meds that remain from a 30 day supply used in the SNF, but no prescriptions. It is expected they will see their own doctor to get their prescriptions. Usually, these patients have not had a primary care doctor prior to this event.

I call and plead with the physician to call in scripts to the pharmacy so the patient will not suffer a relapse. Most insist on seeing the patient first, I can understand that. What frustrates me most, is when the patient sees a provider who is not the pcp, and they do not write the patient any scripts. The patient is told to get them from the PCP. The number one reason patients get re-hospitalized is not taking their medications correctly or in this case not at all.

This reminds me of our yearly safety teaching. Every year we are asked "Who is responsible for safety?" The answer is " everyone". So I ask, who is responsible for making sure there is continuity of care? All of us. If health care providers truly care about improving outcomes and lowering the cost of medical care, they need to stop passing the buck. There has to be a change in the culture of medicine that puts all the responsibility on the primary physician. No patient should be left behind. No patient should have to navigate our complicated web of health care alone. Everyone is accountable. Everyone should treat the patient in front of them as if they are their primary patient.

This happens in nursing, too. How often have patients been told they have to wait for their assigned nurse to minister to their needs? Too often. It also happens in home care. Nurses visiting patients as a substitute for the primary nurse sometimes leave important tasks for the primary nurse to complete. This is not the expectation and holding those accountable has proven difficult.

What is the solution? I think we need to hold each other accountable and making the commitment to putting the patient first and foremost. When we do all we can to assure the patient is going to be successful in mastering their health challenge, patient satisfaction will rise, emergency care will decrease, and costs will become more manageable.

Saturday, October 10, 2015

Failure is a great teacher and motivator. We are all afraid of making mistakes or looking foolish, myself
included. But I have to remember that no one
tries something new and masters it on the first attempt, so why should I
expect learning about blogging would be any different?

I am no stranger to taking on challenging assignments. When I graduated nursing school I started out working in the Operating Room of a community hospital. I had no idea what I was getting myself into. Many a day and night I was terrified I would make a mistake. I did not have a preceptor and I was expected to figure it out. After 6 months, the head nurse informed me my performance was sub par. I had to agree with her, I offered that I was trying as best as I could to learn the job by reading OR texts and observing as much as possible, but without more support, I could not learn the job. She agreed and with more support I was able to take on any assignment with confidence. Eventually, I moved to Boston, where with support and experience, I mastered the role. Several more times in my career, I moved into areas that required special skill sets. The key to success for me has been to get past my fear of failure and working hard to mastering new skills.

I have lived through the dawn of electronic charting. For those of you who have always charted in a computer, you may not be aware of the difficulty it was to transition. Great and experienced nurses were reduced to tears and some even quit nursing. Even for those of us with some computer skills, the software was poorly designed and did not take into account the needs of the clinician. This was before Informatics Nurses and why informatics became a specialty. About 5 years ago, the organization I work for changed over to a new computer
software package. The leader in charge of educating all the staff in using the
program had a saying “You have to make the same mistake six times before you can
master it”.At the time, I found that
prediction to be very annoying, but unfortunately, she was right. I would keep making the same mistakes
until finally, I figured it out and it became second nature.

So here I am, making the same mistakes over and over again. This time, that prediction of making mistakes before mastery is more amusing to me. It has helped me to be more patient with myself as I try to master the skill of blogging. Just using the blog program is a struggle for me. The writing is easy and fun, but creating the page is a whole new skill set. Blogging has opened up a whole new world for me of what is going on in nursing. And for that I again thank The View. If they had not started the firestorm over Kelley Johnson's monologue, who knows how long it would have taken me to discover all those great bloggers and try it for myself.

Tuesday, September 29, 2015

I recently learned about an interesting concept: “positive deviant”. I first read about it in Atul Gawande’s book: better: A Surgeon’s Notes on Performance, How can someone be a deviant and positive? I realized that that is my bias, in my mind deviants are bad, criminals, rule breakers. What I learned is that positive deviants are those who are doing something well, or “make a worthy difference”.

Isn’t that a beautiful notion? How different that is from my definition. It reminds me of how I enjoy it when my library books are overdue and the librarian tells me I am “delinquent”. All my life I have been the good girl, the rule ranger, Miss Goodie Two Shoes. Being a deviant or delinquent feels risky and exciting. I don’t mind being a deviant or delinquent if it means I am becoming a better person or nurse.

Atul Gawande gives 5 suggestions for how one might make a worthy difference. I love them all. I am familiar with them and have been working on them individually, but I never put them all together as he did.

1.Ask an unscripted question. This is the best part of my job, getting to see patients in their homes and learning about them as individuals. Just as he describes, I am often pressed for time: the cell phone rings or the pager goes off in the middle of taking care of a patient, I am already 30 min to an hour behind, I have calls to make and other patients to see. But, I make time to talk about something completely unrelated to my purpose, it is the best part of my day. It does “make the machine feel less like a machine.”

2.Don’t complain. Gawande is completely correct here, no one wants to listen to the complaining. Not your spouse, or your boss, nor your colleagues, and it does “get you down”. This one I am still working on. Having seen it written in the book as eloquently as he wrote, makes me realize I need to work harder on this one.

3. Count something. I realized that a long time ago, just keeping track of something was a way to get me thinking of how to work on the problem. I like to do math in my head, it is a satisfying exercise. I think it also makes your brain mull the problem over and search for solutions.

4.Write something. My husband remarked the other day how I rarely ask for him to proof my papers I write for school. When I was completing my BSN 20 years ago, I would suffer trying to put my ideas on paper and he was an enormous help at the time. Now, I volunteer to write, I feel very comfortable with writing. My first experience with journalling was in one of my grad school classes. I enjoyed it and I meant to continue, but… life, school, work got in the way. After losing someone close to me, I took up journalling to process the conflicted and painful feelings I have. This is another example like don’t complain, people around you, no matter how much they care, get sick and tired of hearing about your grief. Except for those who share in the grief. However, we try to lift each other up more than use one another as a sounding board.

5. Finally, Gawande suggest we Change. I do so want to be an early adopter, I want to make positive change, count my successes (and failures), write about it and not be afraid to ask people what they think. I do so love school, it gives me an opportunity to explore ideas I would not normally explore and challenges me in ways I would never challenge myself.

I am sharing my reflections as Gawande suggests. “The published word is a declaration of membership in that community…”.

Monday, September 28, 2015

The View, inadvertently, has given nurses across the country a platform to share what is that nurses do and how they feel about nursing. Every day we go quietly about our business taking care of patients as if they were our own family members. It is high time the public got an education about what we as nurses do, how dedicated we are to our profession and how important we are to their health. If the View stars had not made their insulting remarks, Miss Colorado's monologue would have faded away. It is because of those careless remarks, millions more watched her performance and were treated to a wonderful example of what it means to do the work of nursing: caring. Not only that, nurses rose up to support one of their own, they found their voice to express what it means to be a nurse. I have never been prouder to be a nurse than I am now. Let us hope this camaraderie continues and spills over into treating each other better. Just as we did not stand for anyone to diminish one of our own, we must not allow lateral violence and incivility among our ranks. Now that we know others are listening and are interested in what we have to say, what should we speak up about next? Safe staffing, creating a better work environment ? What do you think?

10/03/15
I was happy to find this answer to an interview question on the The Mighty Nurse

Mighty Nurse: If you could say one thing to the women on ‘The View’ what would you say?

Kelley: I would say thank you. They have unknowingly banded an army of nurses together, given new life to our profession, and provided an opportunity to educate the world on the importance and necessity of each role within the healthcare team

About Me

I have worked for 40 years in the nursing profession. I discovered a passion for writing on issues affecting nurses during grad school. Currently, I am working with a digital healthcare company helping hospitals to reduce re-admissions and improve recovery for cardiac surgery patients.